Basic Information
| Provider Information | |||||||||
| NPI: | 1841213733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KURUVILLA | ||||||||
| FirstName: | ASHOK | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7173392771 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 V TWIN DR | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | GETTYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173257875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173392790 | ||||||||
| FaxNumber: | 7173392771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD445901 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | ME0062275 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 102723346 | 05 | PA | MEDICAID | 418792 | 01 | PA | UPMC | OTHER | 371525600 | 05 | FL | MEDICAID | 30123102 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 1612004 | 01 | PA | GATEWAY | OTHER |